Alpha-Gal Sensitivity;
A Meat Allergy
What if I told you that you could never eat red meat again?
No more steaks on the grill in the summer… no more Manny’s, Ruth’s Chris, Jeff Ruby’s, Malone’s, Frankie Rowlands, or Mo’s… no, no, nope, nope, and no again.
Why, your gurgling stomach protests, can we not have one of those sizzling plates delivered to the table? You know the one… The waiter gets close to your table and with a subtle flourish, presents the plate and advises ‘It’s still very hot from the grill’. Considering whether to test for potential skin burns, you catch a whiff of the cooked meat. Rich smoky aroma with hints of caramelization rising from the crust… beautifully seared a deep brown with distinct grill marks.
Wait, no. That’s for someone else at the table. The waiter has your vegetarian option… yum!!
Never have another steak, hamburger, or pork chop again? How can that be? What is this ‘meat allergy’?
Alright, let’s back up a bit and set the stage… It’s late May in Middle Tennessee. The weather changes daily and it’s hard to know how to dress. Spring is waving goodbye, but might just pop back in for the last call… Then without warning, the air gets all warm and sticky like a Saturday night mosh pit at Bonnaroo.
Time to top off the tank and crank the mower, 'cause it's that season again. The sun is beating down through clear blue skies and the grass needs cutting. Step out in the yard, take a deep breath of fresh air, and BAM! You’re greeted by a host of parasites ready to hitch a ride on your unsuspecting ankles. Tick season has officially arrived and those little blood-sucking critters are ready to party like it's 1999.
Welcome to my blog and thanks for joining! Today, we will jump into the itchy world of acquired allergies, a condition that has gained attention recently. Alpha Gal Syndrome (AGS) is an allergy with a twist. Primarily transmitted through the close encounter with a Lone Star tick, alpha-gal, (also known as galactose-a 1,3-galactose) is a carbohydrate or sugar that normally hangs out in the tissues of non-primate mammals.
AGS was first described in the early 2000s and lately has become more prevalent in the medical literature. It’s important to note that some of the first observations of the syndrome occurred during the administration of medications that used the sugar molecule galactose-alpha-1,3-galactose during production. Researchers were able to detect the antibody in those reacting to the medication, but it took some time to discover why patients in certain geographic regions were more likely to react. This, in turn, led researchers to link reactions to the bite of the Lone Star Tick, prevalent in the Southeast.
Initial exposure typically happens like this: Ticks ingest the alpha-gal molecule when they feed on the blood of animals that naturally produce it, like mice, deer, and other wildlife. Switching courses, that tick decides to take a bite out of you and because they’re sloppy eaters, that molecule gets into your bloodstream (gross, right?). Once there, the immune system goes ‘Hello, wait… what?’ and starts making antibodies against alpha-gal. Next time you decide to indulge in some juicy red meat or any other alpha-gal-infused goodies, the trouble begins. After a while, your immune system goes into overdrive and throws what every self-respecting Southerner knows to be a ‘hissy fit’.
Reactions can range from mild tummy distress to a full-blown bathroom rodeo. Itchy hives are just the opening acts with severe stomach cramps and diarrhea also coming in as common complaints. More severe reactions can include changes in blood pressure and heart rate, and swelling of the tongue and throat can cause breathing problems. Not the kind of party you want to RSVP to!
My experience with this condition began a few years ago. Second-hand stories of people who developed a ‘beef with beef’ left me confused and fascinated. Hearing anecdotal evidence of symptoms and the number of people affected, I had no idea what it meant in real life.
Sometime later, I began to notice an infrequent issue that occurred late at night or in the early morning. Severe stomach cramps eventually resulted in a full-on intestinal revolt. My red meat intake was relatively low and because symptoms can show up hours after contact, it was difficult to identify a pattern. Only after noticing the late-night appearance of hives did I start to wonder about the possibility of food allergies.
Diagnosing Alpha Gal Syndrome
Alpha-gal sensitivity is still a relatively uncommon allergy. While more information about the prevalence, symptoms, and management of AGS pops up daily, many doctors may need to become more familiar with it. This can lead to misdiagnosis or delayed diagnosis. As in my situation, the symptoms can be subtle. Unlike most food allergies with symptoms occurring within minutes of eating the allergenic food, AGS symptoms can occur 3-8 hours after eating.
If you're worried about your risk of AGS, it's time to have a heart-to-heart with your doctor. They'll be your guide through this wild ride. Your doctor will likely start with a history of any known tick bites, symptoms, and a physical exam to rule out other causes of your symptoms. From there, you may need to undergo blood tests, skin prick tests, or even oral food challenges to determine if you have Alpha-Gal sensitivity. It's important to remember that even if your tests come back negative, you may still have AGS. Some people may experience mild symptoms, such as hives or itching, while others may experience more severe symptoms, such as anaphylaxis. Since these symptoms may be similar to other conditions, such as food poisoning, flu, or anaphylaxis, diagnosing AGS can be difficult.
If you're experiencing symptoms like hives or digestive issues after consuming red meat or dairy, don't hesitate to seek medical attention. In the event of anaphylaxis, call 911. In some cases, Alpha-Gal sufferers have been misdiagnosed for years simply because their symptoms seemed too strange to be real. Trust your instincts and advocate for your health. Remember, knowing is half the battle – getting proper treatment and avoiding trigger foods can make a world of difference for Alpha-Gal patients.
Living with Alpha-gal Sensitivity
When living with AGS, avoidance is the name of the game. Identifying foods and products containing that little sugar can be complicated as they are sometimes included in items not commonly associated with red meat.
Like those math equations, we all hated in school, but with higher stakes. Depending on your degree of sensitivity, some tips on dodging alpha-gal include: Opt for lean cuts - the leaner, the better (no Wagyu, please). Give that fat the snip before you cook your meat and be sure to cook it up nice and done - no pink centers allowed! Steer clear of processed meats like hot dogs, sausage, and bacon (sorry bacon); and become a label detective as alpha-gal can hide in unexpected places, like ice cream, lip balm, some medications, and cosmetics.
As with any severe allergic reaction, strict avoidance and attention to symptoms is critical. Symptoms can increase with time and exposure, so keep your Epi-pen handy.
Prevention
Of course, the very best way to prevent alpha-gal allergy is to avoid being bitten by a lone star tick altogether. Keeping those little beasts at bay is the goal and we do have our weapons for deterrence. First, in the defensive lineup, wear long sleeves and long pants when outdoors to help create a barrier between you and the thirsty swarm… light-colored clothing can help you see ticks before they get attached. Second, we have bug spray that could melt the paint off a Rock City barn roof. You'll be doused in so much DEET, that even the bravest tick would think twice about crossing your path. Third, once you’ve finished your outside venture, be sure and do the tick-check dance. This involves a lot of jumping and shaking to ensure those buggers haven't made themselves at home on your body. It also helps to have a friend check your scalp and back for hitchhikers.
If you do find a tick on your body, don’t panic… just remove it as soon as possible. Using a pair of fine-tipped tweezers, grasp the tick as close to the skin as possible. Pull straight out without twisting or jerking. After removing the tick, clean the bite area with soap and water. Watch the site for signs of infection such as redness or swelling.
Follow up
As I’ve mentioned, this post has been personal since my diagnosis of AGS. It only seems fitting that I close with a personal update. I was officially labeled ‘allergic’ over a year ago. Since that time, I've had minimal contact with red meat. Full disclosure… one Five Guys hamburger (they are so good), a bit of spaghetti on top of chicken parmesan, and one slice of pizza with some random pieces of beef and pepperoni. I’m happy to report no reactions or side effects from any of those encounters. Fish and chicken have become my proteins of choice when eating out or cooking at home… and it turns out Steak Houses also do very well with vegetarian plates.
I’m thankful I've never had breathing difficulties or facial swelling. I do have EpiPens handy but rarely think about them. While there is no cure or vaccine for AGS, there are currently many ongoing studies and practitioners working in the functional medicine field to help manage symptoms and alleviate the sensitivity altogether. Soliman Auricular Allergy Treatment (SAAT) is a relatively new treatment using a small acupuncture needle retained in the ear lobe with tape for several weeks. Reported results seem promising and a significant number of study respondents reported improvement in symptoms. I’ve considered this option and may report on my experience at a later date.
For now, I use my insect spray liberally and my wife is no doubt tired of hearing me say… ‘Check me for ticks please’.
For more information on SAAT
Successful treatment for Alpha-Gal Mammal Product Allergy using Auricular Acupuncture
For more information about Alpha-Gal Syndrome, diagnosis, and treatment
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8344025
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6980324
For more information on early reporting of the reactions to cancer-treating medications
Cetuximab-Induced Anaphylaxis and IgE Specific for Galactose-α-1,3-Galactose | NEJM
questions, comments, or clarifications?
